What is Gout
Gout is a painful type of arthritis resulting from the formation of uric acid crystals in and around the joints. It stands out as the most prevalent form of inflammatory arthritis, with a higher incidence in men and an increased likelihood with advancing age. The condition manifests in individuals with elevated levels of uric acid, also known as urate, in their bloodstream. Urate is a byproduct generated daily when the body breaks down purines, natural chemicals present in our bodies and certain foods. While having urate in the blood is normal and healthy, excessive levels can lead to gout. These crystals primarily accumulate in and around robust joint tissues like cartilage but can also emerge beneath the skin or within internal organs such as the kidneys.
Symptoms of Gout
Symptoms of gout may not be apparent unless an individual is experiencing a gout attack, which typically lasts between five and seven days. During a gout episode, urate crystals can accumulate in the joints unnoticed for an extended period. When a substantial number of these crystals escape from the cartilage into the joint space between two bones, they can rub against the synovium, the soft lining of the joint, causing intense pain, swelling, and inflammation. This event is commonly referred to as a gout attack or flare-up. A flare-up signifies a period during which the symptoms of the condition either resurface or intensify.
Primary Symptoms of gout include:
- Abrupt and intense pain in a joint, typically the big toe, although it may also occur in other joints such as those in the feet, ankles, hands, wrists, elbows, or knees.
- The presence of heated, swollen, and red skin over the affected joint, with the note that redness might be more challenging to discern on individuals with black or brown skin tones.
Where is Gout affected most
Although the big toe is the primary site of gout, other joints may also be affected, including those in the feet, ankles, knees, elbows, wrists, and fingers. It's unusual for gout to occur in central body joints such as the spine, shoulders, or hips. Gout attacks are more prevalent in joints at the extremities of the legs and arms, possibly due to lower temperatures making crystal formation more likely. Tophi, which are small, firm lumps formed by the accumulation of urate crystals outside the joints, may also occur. These tophi can be visible under the skin, often displaying a white color. Common areas for tophi include the top of the toes, back of the heel, front of the knee, backs of the fingers and wrists, around the elbow, and the ears. While tophi are generally not painful, they can interfere with daily activities and may become inflamed, breaking down and leaking fluid with gritty white material – the urate crystals. Tophi can also develop within joints, leading to damage to cartilage and bone, resulting in more regular, daily pain when the affected joints are in use.
What is a Gout Attack
Gout attacks commonly target the joint at the base of the big toe, frequently commencing in the early morning hours. The symptoms progress swiftly, with the most intense discomfort typically experienced within the initial 12 to 24 hours of symptom onset. Even slight contact with the affected joint becomes excruciating, making the mere weight of a bedsheet or the wearing of a sock unbearable. The skin covering the affected joint often exhibits a glossy appearance and may undergo peeling as the gout attack subsides. These episodes typically onset rapidly, often emerging during the night, with doctors categorizing the sudden onset of symptoms as 'acute.' While the attack usually resolves within approximately five to seven days, it may persist for an extended duration if left untreated. Untreated gout can result in more frequent attacks and the potential spread to new joints.
How will it impact me?
The frequency and severity of gout attacks can vary significantly from one person to another. While some individuals may experience an attack only every few years, others may encounter them more frequently, with occurrences happening every few months. Left untreated, gout tends to lead to more frequent attacks, and additional joints may become affected over time. Prolonged exposure to high urate levels and persistent gout can contribute to various health complications, including:
- Narrowing of the arteries, potentially increasing the risk of stroke, heart attacks, or other heart-related issues.
- Osteoarthritis, a condition arising from joint damage caused by urate crystals and hard tophi.
- Elevated risk of developing kidney disease or exacerbation of an existing condition.
- Formation of kidney stones.
- Increased susceptibility to certain cancers, particularly prostate cancer.
- Mental health challenges, including depression.
- Underactive thyroid.
- Erectile dysfunction.
What causes Gout
Gout can be categorized into two types: primary gout, which occurs without a single identifiable cause, and secondary gout, triggered by an underlying factor. Secondary gout may result from:
- Chronic kidney disease
- Prolonged use of medications that impact the kidney's ability to eliminate urate from the body.
Reasons for Gout
- Family history: While kidney health might be optimal, inherited genes can sometimes impede the efficient flushing of urate by the kidneys. This is a prevalent cause of primary gout, especially when multiple family members, such as parents or grandparents, are affected.
- Being overweight: Gout is more prevalent in individuals who are overweight, as higher body weight correlates with increased urate production. Excessive urate production may surpass the kidneys' capacity for filtration. Additionally, being overweight raises the likelihood of having high blood pressure, type 2 diabetes, high cholesterol, and elevated fats in the blood, all of which can decrease urate filtration by the kidneys.
- Gender and age: Gout is approximately four times more common in men than in women. While it can affect men of any age, the risk escalates with age. Women rarely experience gout before menopause, as the hormone estrogen enhances urate filtration by the kidneys. However, post-menopause, estrogen levels decrease, leading to elevated urate levels. Menopause typically occurs between ages 45 and 55, signifying the cessation of natural periods and the end of natural fertility.
- Other conditions: Various conditions are associated with heightened urate levels, either due to their impact on kidney filtration or increased urate production. Conditions like chronic kidney disease, high cholesterol, elevated blood pressure, type 2 diabetes, and osteoarthritis are commonly linked to gout. The relationship with gout may be less clear for some conditions, influenced by numerous factors.
What may initiate a gout attack
Numerous factors can dislodge crystals into the joint cavity, sparking a gout attack. These triggers encompass:
- A blow or injury to the joint.
- Contracting an illness that induces fever.
- Undergoing a surgical procedure.
- Consuming an exceptionally large meal, particularly one rich in fats.
- Excessive alcohol consumption.
- Dehydration.
How to Manage Gout Symptoms
Addressing lifestyle choices may not be the primary cause of gout for most individuals. However, adopting a healthy lifestyle in conjunction with prescribed medications provides the best chance of lowering urate levels, subsequently reducing the likelihood of gout attacks.
Staying Active:
Engaging in regular physical activity is crucial not only for overall health but also for minimizing the risk of gout attacks. Gradually incorporating exercise into your routine, such as dancing, walking in hilly terrain, or playing tennis, can be beneficial. Exercise that induces breathlessness is particularly advantageous. However, during a gout flare-up, it's essential to refrain from exercising to avoid exacerbating pain. Wait until the pain and swelling subside before resuming physical activity.
Healthy Eating:
Maintaining a balanced diet low in fats and added sugars but rich in vegetables and fiber is recommended. Healthy weight management is crucial, as excess weight can strain joints. If overweight, gradual weight loss through a balanced diet and regular exercise is advised. Extreme weight loss or starvation diets should be avoided, as they may elevate urate levels. Diets high in purines, such as Atkins-type weight-loss diets, are not recommended.
Moderation in Food Choices:
Certain foods and drinks can increase uric acid levels. While it's unnecessary to eliminate specific items entirely, consuming large quantities of red meat, game, offal, seafood (especially oily fish and shellfish), yeast extracts, and processed foods should be done in moderation. Protein from sources other than meat and fish, like soybeans, eggs, pulses, or dairy products, can be incorporated into the diet.
Hydration:
For individuals with gout and a history of kidney stones, maintaining hydration by consuming at least two liters of water per day is essential to reduce the risk of stone formation. Avoiding sweetened soft drinks is recommended due to their high sugar content, which can elevate the risk of gout.
Alcohol Consumption:
Excessive alcohol consumption, particularly of beer and spirits, can increase urate levels and the likelihood of triggering gout attacks. Moderation is key, with adherence to government guidelines suggesting no more than 14 units of alcohol per week, equivalent to about 6 pints of beer or 6 glasses of wine, spread across the week.
Vitamin C and Cherries:
Research suggests that vitamin C may slightly reduce uric acid levels, emphasizing the importance of including plenty of fruits and vegetables in the diet. Before considering vitamin C supplements, consultation with a doctor is recommended. Cherries may also reduce the risk of acute gout attacks, particularly when taken with allopurinol.
Skimmed Milk and Low-Fat Yogurt:
Studies indicate that consuming skimmed milk and low-fat yogurt may help prevent gout attacks.
Conclusion:
Finding a personalized combination of treatments and lifestyle adjustments is key to managing gout symptoms and reducing the frequency of attacks. Gout is treatable, and untreated cases can lead to permanent joint damage. It's crucial to consult with healthcare providers about medications and dietary changes to effectively manage symptoms and minimize future gout attacks.